5-5. FACTORS WHICH ALTER A HOSPITALIZED PATIENT'S EATING PATTERNS

The meals served in a hospital cannot accommodate all social and cultural variations in food habits. However, meals can be individualized to assure that patients are provided with foods that are acceptable to them, but still within the restrictions of their diet. A meal, no matter how carefully planned, serves its purpose only if it is eaten. Many factors alter a patient's eating patterns during hospitalization.

a. The forced menu of available foods.

b. Isolation from family and significant others.

c. Restriction in activity.

d. A forced eating schedule.

5-6. FACTORS IN ILLNESS WHICH MAY ALTER FOOD INTAKE

Nutrition plays an important part in a patient's overall condition. A person who is ill may need help in meeting his basic needs for adequate nutrition. Certain factors in illness may alter food intake.

a. The disease processes. The patient's ability to ingest food is dependent upon the condition of his mouth and oral structures, and his ability to swallow. Impairment of any of these components will interfere with eating.

b. Drug therapy, which may alter the patient's appetite.

c. Anxiety about his illness.

d. Loneliness.

e. Diet restrictions. In many disease conditions, a special diet is an important part of therapy. In addition to educating the patient about the diet, you should help him to adapt to the diet and enjoy the food that he can have.

f. Changes in usual activity level. Exercise has been reported to increase, decrease, or have no effect on food intake. Although food intake is decreased immediately after exercise, habitual moderate exercise over a long period of time promotes increased food intake.

5-7. REASONS FOR HOSPITALIZED PATIENTS BEING AT RISK OF MALNUTRITION

a. The effect of the disease on metabolism. Most illnesses and diseases increase the need for nutrients. For example, one of the first symptoms of an infectious disease is loss of appetite and decreased tolerances for food. But, the infection and possible fever increase the metabolic rate and the actual nutrient requirements.

b. The disease may cause problems with absorption. An abnormality in either secretion or motility affects not only digestion but also optimal absorption. Motility is the movement of food through the digestive tract.

(1) Alterations in motility in the esophagus or stomach may result in symptoms of indigestion and vomiting. Increased motility of the gastric contents through the small and large intestines results in decreased absorption and diarrhea.

(2) Conditions that increase motility of the small intestine primarily affect absorption.

c. The anxiety and stress of being ill may reduce the patient's appetite.

d. The treatment may cause problems with intake, digestion, or absorption. The decreased desire to eat may be caused by impaired ability to taste food because of medication, bloating resulting from decreased peristalsis in the gastrointestinal tract following surgery, or nausea resulting from chemotherapy. Withholding food for various tests and procedures, or restricting the patient's intake may affect his appetite.

5.8. NURSING INTERVENTIONS WHICH HELP THE PATIENT MEET NUTRITIONAL NEEDS

Mealtime is an important event in the patient's long day and the patient's diet is an integral part of the total treatment plan. Certain nursing interventions may help the patient meet his or her nutritional needs.

a. Consider the patient's food preferences as much as possible. Encourage the patient to fill out the selective menu, so that preferred foods will be served.

b. Provide the patient with assistance in selecting the appropriate foods from the menu. The use of selective menus has improved food acceptance in most hospitals.

c. Order and deliver the patient's tray promptly when it has been delayed while he was undergoing tests or procedures.

d. Feed or assist the patient as necessary. Even patients, who can feed themselves, may need assistance in opening milk cartons, cutting meat, and spreading butter on bread.

e. Discuss the advantages of following the diet. Explain to the patient why he will feel better and heal faster. For some diseases or disorders, the patient may be required to follow a special diet during the period of illness or the remainder of his life.

(1) A high protein diet is essential to repair tissues in any condition, which involves healing, such as recovery from surgery or burns.

(2) A person with diabetes must adhere to a diet controlled in calories, carbohydrates, protein, and fat.

(3) A person with hypertension may require a diet restricted in sodium.

f. Inform the dietitian or food service specialist of any special needs the patient may have. A patient who has lost his teeth and has difficulty chewing will need modifications in the consistency of the food he eats.

g. Visit with the patient briefly when serving the food tray.

h. Encourage family members to visit during mealtime. If present, a family member may want to feed the patient who needs assistance. Be sure that this is relaxing and safe for the patient.

i. When conditions allow for it, encourage the ambulatory patient to go to the dining hall for meals or open curtains in a double room so that patients may eat together. If the patient must eat alone, turn on the television or radio.